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A survey from the American College of Healthcare Executives reaffirms the top issues affecting community hospital leaders. Among the top-of-mind issues: Government funding cuts, the shift to value-based purchasing, and CMS and state regulations.

For the tenth straight year "financial challenges" have been listed as the number one concern of healthcare executives, according to an annual survey from the American College of Healthcare Executives.

Coming in second was healthcare reform implementation, followed by government mandates, and patient safety and quality, both of which ranked third.

"You've heard the famous quote: No margin no mission. This just reflects the enormous stresses that hospitals are under right now," says Deborah J. Bowen, president/CEO of ACHE.

"Everybody is reducing operating costs and thinking differently about how they are going about moving from fee-for-service to these value-based payments where quality and finances are accounted for. It's not business as usual by any stretch of the imagination."

The 388 community hospital CEOs who responded to the survey were asked to rank 11 issues affecting their hospitals in order of importance and to identify specific areas of concern within each of those issues.

Among financial concerns, for example, government funding cuts ranked highest, led by inadequate reimbursements for Medicare and Medicaid, followed by an anticipated increase in bad debt due to high-deductible health plans, decreasing patient volumes, staffing costs, competition from other providers, and inadequate funding for capital improvements.